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Biomedical subjects

J Laugier

Publications and source records attributed to J Laugier.

At least 19 recordsLinked to original sources
PubMed1992

Liver dysfunction and acute cardiocirculatory failure in children.

We report 15 children who developed transient liver dysfunction related to hepatic ischaemia. All patients had cardiocirculatory failure 24 h before the onset of liver injury (day 1). Peak serum values of transaminases occurred between day 1 and day 3: SGOT (mean: 759 IU/l, range: 150-4400); SGPT (418 IU/l, 95-2547). Transaminase values decreased rapidly and normalised from day 6 to day 10. Minimum values of prothrombin test (PT) occurred on day 1 (31%, 10-70) and 13/15 patients had a PT less than 50% (27%, 10-44). PT values normalized from day 3 to day 10. Hypoglycaemia was present in 8/15 patients on day 1. Liver dysfunction improved after correction of the circulatory failure. These results confirm that transient hepatic dysfunction, probably as a consequence of hepatic hypoperfusion, may occur frequently in children after acute circulatory failure. We conclude that the diagnosis of ischaemic liver injury or shock liver syndrome in children can be made on clinical and biochemical criteria, and that liver biopsy is unnecessary.

Acute Disease↗
PubMed1992

Perinatal pharmacology and cerebral blood flow.

Many of the drugs used in neonatal intensive care units might impede cerebral blood flow, thereby increasing the risk of intraventricular hemorrhage and periventricular leukomalacia. Our studies focussed on sick preterm neonates who were treated with the following drugs: caffeine (20 mg/kg i.v., as caffeine citrate); phenobarbital (loading dose: 20 mg/kg); indomethacin (0.2 mg/kg/dose, every 12 h three doses), and synthetic surfactant (Exosurf; 50 mg/kg = 5 ml/kg intratracheally). All of the drugs studied, except indomethacin, had no adverse effect on cerebral hemodynamics.

Arteries↗
PubMed1992

[Enteropathy in premature newborn infants. Prospective study over one year].

BACKGROUND: In neonatal units, there is a tendency to assume that any acutely sick infant with gastro-intestinal symptoms has necrotizing enterocolitis (NEC). This prospective study was conducted to find a better definition of enteropathy in preterm neonates and their risk factors. MATERIAL AND METHODS: All the 351 preterm neonates admitted to a neonatal unit from 1 August 1988 to 31 July 1989 were included in the study. A chart including 45 items was established for each infant, with special attention to data on the pregnancy, delivery, any early ischemic and/or infectious problem, nutrition and any gastro-intestinal (GI) problem. All the neonates were fed similarly, depending their maturation, gestational age and GI status. Each infant was assigned to one of 5 categories: 1) no GI problem; 2) transient obstruction; 3) NEC with pneumatosis; 4) hemorrhagic colitis without obstruction or pneumatosis; 5) other GI disease. RESULTS: 267 infants had no GI problem during their stay in the neonatal unit. 53 developed GI symptoms: 23 transient obstructions, 6 NEC, and 24 hemorrhagic colitis. The mean age at onset of symptoms in these last 3 categories was 7 days, 14 days and 23 days, respectively. Ten risk factors were found to be significantly correlated with GI disturbances: umbilical venous catheter, benzodiazepines, birth weight < 1,500 g, patent ductus arteriosus, ventilatory assistance, abnormal amniotic fluid, gestational age < 32 weeks, early antibiotic treatment, passage of meconium > 48 hours, episodes of apnoea and/or bradycardia. CONCLUSION: This follow-up shows that the GI disturbances of preterm neonates admitted to a neonatal unit, specially those having one or more risk factors, can be separated into 3 groups: 1) isolated intestinal obstruction, seen in the most immature babies during the first week of life with the risk of developing NEC; 2) frank blood in the stool, indicating colitis and possibly minor forms of NEC; 3) combined obstructive and hemorrhagic symptoms, typical of NEC.

Digestive System Diseases↗
PubMed1992

[Effect of the administration of cefixime on aerobic fecal flora in children].

The ecological effect of cefixime on aerobic fecal flora was evaluated in 6 children aged 2 to 5 years given oral cefixime (8 mg/kg/day in two divided doses) for five days. Serial dilutions of stools recovered at baseline (D0), 2 and 5 days after initiation of therapy (D2 and D5) and two days after completion of therapy (DC + 2) were cultured on selective media. Colonies of Enterobacteriaceae, group D streptococci, staphylococci, and Candida were counted. A moderate but significant (p less than 0.01) decrease in the Enterobacteriaceae count was seen, with a fall from 8 log 10 (4.8 to 9.4) on D0 to 6.4 (3.6-9) on D2, 6 (4.6-7.2) on D5 and 4.7 (2-8.2) on DC + 2. No cefixime-resistant Entrobacteriaceae or Pseudomonas strains were evidenced. A slight, non significant decrease in group D streptococci counts was found, with values of 7.1, 7.1, 5.8, and 8.3 log 10 at the successive time points. All children exhibited fecal staphylococcal strains which were all coagulase-negative and which did not undergo noticeable quantitative changes (mean successive values were 2.5, 1.8, 3.5, and 3.8 log 10). Candida were found in four children and also changed little over time (mean successive values: 2, 1.7, 2, and 2.6 log 10). In sum, oral administration of cefixime was associated with a modest decrease in the number of Enterobacteriaceae, with no development of resistance to cefixime.

Administration, Oral↗
PubMed1992

[Contribution of two-dimensional echography in predicting spontaneous closure of interventricular defects in infants].

The aim of this study was to assess the evolution of ventricular septal defects (VSD) with respect to their initial echocardiographic appearances: size and site. One hundred consecutive neonates under 3 months of age with a typical VSD murmur, were included in a prospective study. Malformation syndromes and associated cardiac disease were criteria of exclusion. Disappearance of the murmur was indicative of closure of the VSD. The VSDs were classified as: small (diameter less than or equal to 3 mm), medium (3 to 6 mm) and large (greater than 6 mm). Twelve children were lost to follow-up; the remainder were followed up for an average of 35 months. The VSDs were muscular (39%), membranous (37%), infundibular (2%) or unlocalised (22%). Of the muscular VSDs, 85% were small and 15% were medium-sized; 48% of membranous VSDs were small, 43% were medium and 9% large-sized. Spontaneous closure was observed in 64% of cases but this figure varied with the size and site of the VSD. The prognosis of unlocalised VSDs was excellent (100% spontaneous closures at 1 year), as was that of small muscular VSDs (89% spontaneous closures at 1 year). The prognosis of medium size muscular and small membranous VSDs was less favourable: 40% closures at 1 year, 50% closures at 2 years respectively. The closure of medium-sized membranous VSDs was slower: 7% at 2 years. It was essentially in this group and that of large-sized membranous VSDs that the surgical indications were mostly to be found. No spontaneous closures were observed in the large membranous or the infundibular VSDs.

Age Factors↗
PubMed1992

[Rashkind atrio-septostomy in incubators and neonatal intensive care units].

In 7 neonates with cyanotic heart disease, balloon atrial septostomy was performed in the neonatal intensive care unit under two-dimensional echocardiographic control. Trans-umbilical route was used with success in 6 neonates and percutaneous femoral vein in 1 neonate after failure of the trans-umbilical route. The mean transcutaneous oxygen saturation increase was 22%. No complications were observed. The average duration of the procedure was 25 minutes. Thus this technique is efficient, quick and easy to perform, allowing the procedure to be done under optimal environmental conditions in critically ill neonates.

Catheterization↗
PubMed1992

[Surveillance of antibiotic therapy in a pediatric intensive care unit].

Since 1982, a pediatric intensive care unit for neonates and pediatric patients up to 15 years of age has prospectively recorded every instance of use of antimicrobials, with the reasons for use, clinical and bacteriological parameters, and outcome. This approach encourages strict adherence to established protocols and provides a basis for discussing the rationale of each antimicrobial course. Effectiveness of protocols is evaluated annually and modifications or additions are introduced, as appropriate. Patterns in the proportion and nature of antimicrobials used to treat hospital-acquired infections can be monitored on the basis of the data collected. Changes in the nature of antimicrobials used, which may have repercussions on pathogen resistance to antimicrobials, are also monitored. Reasons for use of antimicrobials are categorized as follows: A = primary infection: B = secondary infection acquired in the ICU; C: secondary infection acquired in another unit or in another hospital; D = prophylaxis. In 1987, 46% of neonates and 59% of patients above one month of age were given antimicrobial agents; these figures are similar to those recorded during the previous years. Reasons for antimicrobial therapy were as follows in neonates: A = 48.5%; B = 40%; C = 1.2%; D = 10.3%; in patients above one month of age corresponding figures were: A = 23%; B = 44%; C = 0.9%; D = 31.9%. Among the neonates, the ampicillin-aminoglycoside combinations accounted for 41.5% of treatments (1/4th of these treatments were continued); in the older patients, penicillin G and ampicillin were the most commonly used antibiotics. In all age groups, hospital-acquired infections were mainly respiratory tract infections (approximately 50% in neonates and 80% in patients above one month of age). Staphylococcus aureus was the most prevalent organism; Pseudomonas was seen virtually only among the patients above one month of age with very prolonged endotracheal intubation. From 1983 through 1987, use of third-generation cephalosporins increased from 4.5% to 28.3% in neonates and from 5.5% to 9% for patients above one month of age. The changes identified over time should be interpreted in the light of changing patterns of disease; in particular, hospital-acquired infections among neonates increased twofold, probably as a result of the rising number of very-low-birth-weight infants.

Adolescent↗
PubMed1992

[Bacterial infection of the newborn by maternal fetal contamination: one can depend on the anamnesis].

All babies born in a University maternity unit over a period of four months had bacteriological swabs taken in the labour ward. This was to see whether a list of criteria in the history for bacterial infection of the newborn could be relied on. The criteria were: premature rupture of the membranes (before labour had started at all), rupture of the membranes for more than 12 hours, stained liquor, prematurity, fetal tachycardia of more than 160 per minute or abnormal rhythm of the heartbeat, an Apgar score of less than 7 after 1 minute, maternal genital or urinary tract infection (not cured) in month before delivery, maternal temperature above 38 degrees C in labour. During the study there were: 570 live births of which 222 (39%) were at risk of infection according to the above list of criteria, 35 had bacterial colonies present and 4 were definitely infected. More cultures from the placenta, the gastric fluid and the skin came back positive when there was a recognised risk of infection. Both the clinical and bacteriological results show that the risk was 5.24 of colonisation when the risk of infection had been recognised. These prospective results when checked against the retrospective results already obtained in the same department, suggest that this kind of screening for infection is worthwhile without being too expensive, and one can rely on the history to screen for neonatal bacterial infection.

Apgar Score↗
PubMed1992

Doppler assessment of the cerebral circulation in pediatric intensive care.

This article gives an interim overview of the potentials of TCD as a monitoring instrument in pediatric intensive care. In the near future, typical TCD flow patterns associated with adverse neurologic outcomes must be defined so they can promptly be recognized during intensive care surveillance or intraoperatively, before permanent damage occurs. Further applications of monitoring will deliver new and exciting insights into the physiology and pathophysiology of cerebral circulation in the critically ill child. Continuous recording of the Doppler waveforms and ICP may make it possible to determine the critical CPP and to improve the control of the therapy of cerebral edema.

Blood Flow Velocity↗
PubMed1991

Intraoperative measurements of cerebral haemodynamics during ductus arteriosus ligation in preterm infants.

Intraoperative Doppler sonographic examinations were carried out on seven preterm neonates to measure cerebral blood flow velocity changes in the anterior cerebral arteries during ductus arteriosus ligation. Age at surgery was 12 +/- 6 days. Continuous recordings during the operative procedure showed a rapid increase in diastolic blood pressure (P less than 0.01), whereas systolic blood pressure was not significantly higher compared with pre-occlusion values. In the anterior cerebral arteries, ductal closure led to a decrease in resistance index of Pourcelot (mean = 1.02 +/- 0.08 vs 0.65 +/- 0.07 (P less than 0.001)) and to an increase in area under the velocity curve (mean = 3.64 +/- 0.38 vs 8.16 +/- 1.07 (P less than 0.001)). These changes were associated with a corresponding increase of the end diastolic flow velocity (P less than 0.001) but no change in the peak systolic velocity. The heart rate did not change significantly during ductal closure. TcPO2, TcPCO2 remained normal during the study period. These data indicate that changes in cerebral blood flow velocity during surgical ligation are principally determined by changes in systemic diastolic pressure. Systolic blood pressure and peak systolic flow velocity remain unchanged or slightly higher than preligation values, thereby restoring normal cerebral blood flow velocity pattern without increasing the stress on the wall of cerebral vessels and thus the risk of peri-intraventricular haemorrhage.

Blood Flow Velocity↗
PubMed1991

Effects of phenobarbital on cerebral hemodynamics in preterm neonates.

The effect of phenobarbital on cerebral blood flow velocity (CBFV) was studied in 12 clinically stable preterm neonates to evaluate possible mechanisms underlying its protective effect on intracranial hemorrhage. Phenobarbital at loading doses of 20 mg/kg, or placebo (saline) were given intravenously. The study was a cross-over study, each infant successively received placebo, then phenobarbital. Simultaneous recording of heart rate, mean arterial blood pressure (MABP), blood gases were made before, at the end of the injection, and at 15, 30, 60, 90 and 120 min after the end of each administration of either placebo or phenobarbital. Compared with placebo, phenobarbital injection was not associated with significant changes in CBFV and MABP. Heart rate, blood gases did not change significantly. Our data suggest that the protective effect of phenobarbital may minimally be mediated by a direct effect on cerebral blood flow.

Birth Weight↗
PubMed1991

[Newborn bacterial infection caused by materno-fetal contamination. Retrospective epidemiologic study at a maternity unit].

A retrospective epidemiological study of neonatal bacterial infection due to contamination from the mother was carried out in maternity unit. We analysed the results of taking bacterial swabs from the skin and GI tract in newborn children when there was a possibility, or even probability, from the criteria given that there would be infection. These results compare with different criteria. In 19 months there were 2,622 live born children; 40.6% of those had swabs taken; the infection rate was 0.61% of newborns, but 16% of the newborns, had asymptomatic colonisation by bacteria. The high risks of finding positive swabs as shown by increased infection rates by colonisation occurred where the mothers had high temperatures. Our results led us to change the criteria for antibiotic treatment immediately after birth, in newborn babies.

Bacterial Infections↗
PubMed1991

[Purulent meningitis due to flavobacterium meningosepticum in Cameroonian children].

Following a number of reports of purulent CSF specimens positive for Flavobacterium meningosepticum in pediatric patients in Yaoundé, a prospective study was carried out in the Department of Pediatrics of the Central Yaoundé Hospital from December 1988 through December 1989. The goals of this study were to determine the incidence of Flavobacterium meningosepticum among infants and children with purulent meningitis, to discover the origin of this pathogen, and to examine its susceptibility to antimicrobial agents. Flavobacterium meningosepticum (18.4% of cases) was second by order of incidence, after pneumococci (50%). Incidences were low for the other pathogens usually described in purulent meningitis (H. influenzae, meningococcus...). All the pneumococcus strains recovered were susceptible to ampicillin. In contrast, 21.43% of strains of Flavobacterium meningosepticum were resistant to both ampicillin and chloramphenicol (the combination currently used as first line therapy in the Department), and 14.25% of strains were resistant to cefotaxime. The origin of the Flavobacterium meningosepticum strains found remains to be discovered. The low incidence of H. influenzae deserves to be reevaluated over the next few years.

Adolescent↗
PubMed1990

Area of lateral ventricles measured on cranial ultrasonography in preterm infants: reference range.

Serial ultrasound imaging of the brain was carried out in 87 preterm infants of 27 to 36 weeks' gestational age while they were in the special care nursery and during their first postnatal year. None had evidence of intracranial disease during the neonatal period and 94% had good neurodevelopmental outcome at 2 years of age. Lateral ventricle area measurements were plotted against independent variables including postnatal age and head circumference at the time of the examination. The measurements increased as age and head circumference increased. During the first six weeks of life the mean (SD) postnatal head circumference growth velocity (rate of growth) was 0.53 (0.13) cm/week and the mean postnatal ventricular area growth velocity was 0.39 (0.19) mm2/week. A reference range for lateral ventricle area values was developed from these serial measurements in infants with documented good short term developmental outcome.

Age Factors↗